March 2007

Grant Results


Staff of the Health Research and Educational Trust (HRET), an independent affiliate of the American Hospital Association, worked with a national advisory group to redesign its Creating Healthier Communities (CHC) Fellowship Program.

This leadership-training program for health professionals in community health ran for 12 years, starting in 1990. It aimed to enhance the collaboration and leadership skills of the fellows and their ability to design and implement projects to improve community health.

Key Results

  • The new program will focus on creating and sustaining innovation in organizations and communities.
  • Participants in the new program will work collectively on a project related to innovation. The goal is to have each cohort function as a learning community. Members of learning communities learn together — sharing ideas and finding solutions as a group.

As of December 2006, HRET staff continued to develop the new program. The program was scheduled to launch in 2007.

The Robert Wood Johnson Foundation (RWJF) provided HRET with a $100,000 grant to support the program's redesign from December 2004 through November 2005.

 See Grant Detail & Contact Information
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For 12 years during the 1990s and early 2000s, HRET offered a leadership-training program for health professionals involved in improving community health. The program aimed to enhance the collaboration and leadership skills of the fellows and their ability to design and implement projects to improve community health.

The 15-month fellowship began with classroom learning about leadership theories. Each fellow then designed and implemented an individual community project. The program trained more than 500 people.

By the early 2000s, however, enrollment in the fellowship program had declined as hospitals and other organizations became reluctant to assign scarce resources to efforts that did not result in immediate cost savings or quality improvements. At the same time, HRET staff members observed that the prevalence of chronic diseases and the aging population continued to strain the health system.

HRET staff proposed to redesign the fellowship program to make it more relevant to organizations and communities operating in a difficult and changing health care market.

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RWJF's Building Human Capital team made this grant. The team's strategy is to nurture a strong, capable health and health care workforce through leadership development, training and research funding for a diverse group of professionals and academics from local public health workers to clinical researchers to health care policy analysts.

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HRET undertook the following activities to develop the new program:

  • Project staff convened a national advisory group to recommend content, format, faculty and types of participants. Advisers included public health physicians, representatives of hospitals and hospital associations, and leaders of community health programs. (See the Appendix for a list of advisory group members.) Their expertise included strategic planning, business models and disease management strategies.
  • HRET staff facilitated five meetings of the advisory group between February and July 2005. The advisory group recommended that a new program help participants:
    • Explore innovation models and practices that have implications for problem solving
    • Identify and develop sustainable initiatives for improving individual and population health
    • Focus on those conditions that represent the major burden of disease in the United States, including chronic conditions such as cardiovascular disease and mental illness, and behaviors such as smoking that are risk factors for disease.
  • Staff conducted more than 150 interviews with members of the advisory group, additional experts recommended by the advisers and former fellows. Key insights from this research included:
    • Community health is a critical driver for improving health outcomes.
    • Payers, providers and consumers must be involved to improve community health.
    • An evidence-based approach to creating community health is needed.
    • Efforts to create healthy communities must demonstrate a return on investment.
    • Chronic diseases should receive attention in any new program.
    • Adult learners want to have meaningful experiences, as well as being provided with tools and methods.
  • Staff conducted two focus groups at a national meeting of the American Hospital Association in July 2005. The goal of the focus groups was to find out how potential audiences for the fellowship would react to the recommendations of the advisory group. The focus groups drew from a cross section of operational, clinical and community representatives. Members of both focus groups believed the recommendations pointed to useful and productive activities, according to the project director.


The greatest challenge to the project was its time line. The advisory group's recommendations were completed as scheduled in 2005, but staff needed more time than initially anticipated to shape the recommendations into a new program offering. The project director reflected that a small, core group of advisers and staff members working together throughout the process might have expedited the project. See Lessons Learned.

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The new program — still under development — will aim to expose participants to innovations in the areas of patient-centered health care, business disciplines and community engagement. Key features of the program follow:

  • The new program will focus on how to create and sustain innovations in organizations and communities. Chronic disease management, business perspectives and the building of collaborative relationships will be integrated into the overarching theme of innovation.
  • Each cohort of participants will visit three learning sites. Staff at HRET will select sites for their innovative practices in community health. At each site, participants will have classroom instruction, followed by on-site exposure to the innovation that the site has developed. Between visits to the three learning sites, participants will continue to communicate online in a method still under development as of December 2006.
    • One potential learning site is the Memorial Healthcare System of Hollywood, Fla., which won the American Hospital Association's "Living the Vision" award in 1997. The award recognized the health system for its commitment to improving the management of chronic disease throughout its community with the help of a public/private partnership of community-based organizations. Memorial Healthcare engaged many of these organizations in funding the partnership and in the case management of indigent individuals and patients with Medicaid coverage, as well as employed individuals suffering health conditions as asthma, diabetes, HIV/AIDS and chronic heart failure.
  • Participation in the new program will aim to be much broader than that under the previous fellowship program. In addition to participants from hospitals and community health organizations, participants in the new program will also represent:
    • Payers: Health plans, insurance companies, employers and Centers for Medicare & Medicaid Services.
    • Providers: Hospital and health systems, academic medical centers, public health practices, disease-management organizations, community-based health providers, pharmaceutical companies, health-related corporations and information technology companies.
    • The public: Community-based organizations, public officials, consumer groups, local businesses and the financial community.
  • Participants in the new program will work collectively on a project related to innovation. The goal is to have each cohort function as a learning community. Members of learning communities will learn together — sharing ideas and finding solutions as a group.

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  1. Having an internal core committee involved in the process from beginning to end would have expedited the project. A consistent core group of four to five people would have created better continuity in managing and processing the large amount of information that needed to be reviewed and incorporated into a concrete program. (Project Director)

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As of December 2006, HRET staff members continued to develop the new program. They assembled a new advisory group, which they broadened to include payers, providers and health care consumers. They charged the new group with developing criteria for the selection of learning sites.

HRET staff continued to work on the program structure, format and length, as well as the model. Long-term plans call for the development of a strategy to disseminate widely the results of the group projects. Until the plan is developed, HRET will post reports on its Web site.

The program is scheduled to launch in 2007.

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Redesigning the Creating Healthier Communities Fellowship Program


Health Research and Educational Trust (Chicago,  IL)

  • Amount: $ 100,000
    Dates: December 2004 to November 2005
    ID#:  051342


Duffy Newman
(415) 248-8405

Web Site

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Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Fellowship Design National Advisory Group

Darvin Ayre
Ayre & Associates
Boulder, Colo.

Eric Baumgartner, M.D., M.P.H.
Program Planning and Policy Specialist
Louisiana Public Health Institute
New Orleans, La.

Clyde Beck Jr., M.D.
Vice President of Institutional Development
Scripps Health Foundation
San Diego, Calif.

Leanne Kaiser Carlson
Kaiser Institute
Brighton, Colo.

John Combes, M.D.
Center for Healthcare Governance
Chicago, Ill.

Linda DeWolf
VHA Health Foundation
Irving, Texas

Len Duhl, M.D.
School of Public Health
University of California, Berkeley
Berkeley, Calif.

Joyce Essien, M.D., M.B.A.
Founder & Director
The Center for Public Health Practice
Rollins School of Public Health
Emory University
Atlanta, Ga.

Rita Harmata
Director, Trustee & Community Leadership
Member Relations
American Hospital Association
Chicago, Ill.

Jody Hereford, R.N., M.S.
Hereford Consulting Group
Boulder, Colo.

Lyn Hester
Vice President, Community Services
Oklahoma City, Okla.

Kathryn Johnson
HRET Fellowship Programs
Kentfield, Calif.

John Kesler, Esq.
Learning Democracy Associates
Salt Lake City, Utah

Deborah Knight-Kerr
Director, Community and Education Projects
Johns Hopkins Hospital
Baltimore, Md.

Lowell Kruse, M.H.A.
President and CEO
Heartland Health
St. Joseph, Mo.

Anita Lee, Dr.Ph., M.P.H.
Administrator, Community Health and Grants
New York Presbyterian Hospital
New York, N.Y.

Martha Lee
Executive Director
Kellogg Fellows Leadership Alliance
Denver, Colo.

Robert Lee
Executive Director
Lancaster Community Health Plan
Lancaster, Pa.

Nick Macchione, M.S., M.P.H., C.H.E.
Deputy Director and General Manager
San Diego County Health & Human Services
Oceanside, Calif.

Martha Maksym, M.P.A.
Director, Community Services
United Way of Chittenden County
Burlington, Vt.

Philip Newbold
President & CEO
Memorial Health System
South Bend, Ind.

Tyler Norris
Quality Data Management
Boulder, Colo.

Constance Pechura, Ph.D.
Senior Program Officer
Robert Wood Johnson Foundation
Princeton, N.J.

Mary Pittman, Dr.P.H.
Health Research and Educational Trust
Chicago, Ill.

Leslie Porth, R.N.C., M.P.H.
Vice President, Health Improvement
Missouri Hospital Association
Jefferson City, Mo.

Marilyn Tubb, M.A.
Vice President, Community Affairs
Shands HealthCare
Gainesville, Fla.

Robin Wilcox
Vice President, Community Health
Texas Health Resources
Arlington, Texas

Maryjane Wurth
Chief Operating Officer
Healthcare Association of New York State
Rensselaer, N.Y.

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Report prepared by: Nina Berlin
Reviewed by: Janet Heroux
Reviewed by: Molly McKaughan
Program Officer: Jeane Ann Grisso